Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 5 Issue 2

Is Enhanced Recovery After Surgery Pathway (ERAS) Influential in Reducing Length of Patients Stay in Colorectal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Salah Nashi AlOtaibi*

Consultant Cardiac Anesthesiologist, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

*Corresponding Author: Salah Nashi AlOtaibi, Consultant Cardiac Anesthesiologist, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

Received: March 29, 2021; Published: May 29, 2021

Abstract

Background: A systematic review and meta-analysis was conducted after identifying from the literature that enhanced recovery after surgery (ERAS) pathway reduces length of stay (LOS) and control health expenses after colorectal surgery. This review paper follows PRISMA guidelines and retrieved randomized controlled trials (RCTs) to assess the efficacy of ERAS pathway in reducing LOS after colorectal surgical discharge. In addition, this review paper aims to evaluate other post-operative complications such as mortality rates, costs, and readmission rates with the implementation of ERAS pathway.

Methods: Eligible RCTs (n = 17) were included in this review paper from PubMed, CINAHL Plus, EMBASE, and MEDLINE from January 1st 2011 and March 31st 2020. Each trial was cross-checked in terms of its publication bias and quality rigor. Restrictions were set for English publications only.

Results: A total of 7500 patients were included in 17 RCTs. The ERAS pathway was associated to shorter mean LOS [MD = -1.07 days, (-1.99, -0.15), p for effect < 0.001, p for heterogeneity < 0.0001, I2 = 98%] without increasing readmission rates and cost associated to colorectal surgery. Mortality rates were also controlled with the implementation of ERAS pathway as compared to standard care.

Conclusion: There was significant evidence in reduction in mean LOS after colorectal surgery with the implementation of ERAS pathways. The appropriate ERAS pathway implementation results in controlling other secondary complications.

Keywords: Colorectal Surgery; ERAS; Length of Stay; Randomized Controlled Trials

References

  1. Gatt M., et al. “Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection”. British Journal of Surgery11 (2005): 1354-1362.
  2. Zargar‐Shoshtari K and Hill AG. “Optimization of perioperative care for colonic surgery: a review of the evidence”. ANZ Journal of Surgery1‐2 (2008): 13-23.
  3. Pędziwiatr M., et al. “Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery”. Medical Oncology6 (2018): 95.
  4. Bagnall NM., et al. “A systematic review of enhanced recovery care after colorectal surgery in elderly patients”. Colorectal Disease12 (2014): 947-956.
  5. Rawlinson A., et al. “A systematic review of enhanced recovery protocols in colorectal surgery”. The Annals of The Royal College of Surgeons of England8 (2011): 583-588.
  6. Patel HR., et al. “Enhanced recovery after surgery: are we ready, and can we afford not to implement these pathways for patients undergoing radical cystectomy”. European Urology 2 (2014): 263-266.
  7. Ljungqvist O. “ERAS—enhanced recovery after surgery: moving evidence‐based perioperative care to practice”. Journal of Parenteral and Enteral Nutrition 5 (2014): 559-566.
  8. Muller S., et al. “A fast-track program reduces complications and length of hospital stay after open colonic surgery”. Gastroenterology3 (2009): 842-847.
  9. Šerclová Z., et al. “Fast-track in open intestinal surgery: prospective randomized study (Clinical Trials Gov Identifier no. NCT00123456)”. Clinical Nutrition6 (2009): 618-624.
  10. Khuri SF., et al. “Determinants of long-term survival after major surgery and the adverse effect of postoperative complications”. Annals of Surgery3 (2005): 326.
  11. Birkmeyer JD., et al. “Hospital quality and the cost of inpatient surgery in the United States”. Annals of Surgery1 (2012): 1.
  12. Coolsen MM., et al. “A systematic review of outcomes in patients undergoing liver surgery in an enhanced recovery after surgery pathways”. Hpb4 (2013): 245-251.
  13. Zhao Y., et al. “Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials”. Medicine 31 (2017).
  14. Wu SJ., et al. “Fast-track programs for liver surgery: a meta-analysis”. Journal of Gastrointestinal Surgery9 (2015): 1640-1652.
  15. Wang C., et al. “Enhanced recovery after surgery programs for liver resection: a meta-analysis”. Journal of Gastrointestinal Surgery3 (2017): 472-486.
  16. Rouxel P and Beloeil H. “Enhanced recovery after hepatectomy: a systematic review”. Anaesthesia Critical Care and Pain Medicine1 (2019): 29-34.
  17. Moher D., et al. “CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials”. International Journal of Surgery1 (2012): 28-55.
  18. Aravani A., et al. “A retrospective observational study of length of stay in hospital after colorectal cancer surgery in England (1998–2010)”. Medicine47 (2016).
  19. Aydin HO., et al. “Long-term and Perioperative Outcomes of Laparoscopic and Open Surgery for Rectal Cancer”. The Medical Bulletin of Sisli Etfal Hospital 4 (2018): 285-288.
  20. Chand M., et al. “The influence of peri-operative factors for accelerated discharge following laparoscopic colorectal surgery when combined with an enhanced recovery after surgery (ERAS) pathway”. International Journal of Surgery 25 (2016): 59-63.
  21. Chiu HC., et al. “The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients”. Journal of International Medical Research2 (2017): 691-705.
  22. Elsoud MR and Soror MG. “Discharging patients after colorectal surgery: a Medical Research Institute experience”. The Egyptian Journal of Surgery4 (2015): 264.
  23. Forsmo HM., et al. “Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial”. Colorectal Disease6 (2016): 603-611.
  24. Huebner M., et al. “Timing of complications and length of stay after rectal cancer surgery”. Journal of the American College of Surgeons5 (2014): 914-919.
  25. Lee G., et al. “Impact of patient’s pain and fatigue on decision of discharge after laparoscopic surgery for colorectal cancer”. Annals of Coloproctology4 (2019): 209.
  26. Li K., et al. “Fast-track improves post-operative nutrition and outcomes of colorectal surgery: a single-center prospective trial in China”. Asia Pacific Journal of Clinical Nutrition1 (2014): 41.
  27. Ripollés-Melchor J., et al. “Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study”. Revista brasileira de anestesiologia4 (2018): 358-368.
  28. Miller TE., et al. “Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol”. Anesthesia and Analgesia5 (2014): 1052-1061.
  29. Greco M., et al. “Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials”. World Journal of Surgery6 (2014): 1531-1541.
  30. Thanh NX., et al. “An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta”. Canadian Journal of Surgery6 (2016): 415.
  31. Feng F., et al. “Fast‐track surgery combined with laparoscopy could improve postoperative recovery of low‐risk rectal cancer patients: A randomized controlled clinical trial”. Journal of Digestive Diseases6 (2014): 306-313.
  32. Wang H., et al. “Short-term quality of life in patients undergoing colonic surgery using enhanced recovery after surgery program versus conventional perioperative management”. Quality of Life Research11 (2015): 2663-2670.
  33. Aarts MA., et al. “Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay”. Surgical Endoscopy2 (2012): 442-450.
  34. Abraham N and Albayati S. “Enhanced recovery after surgery programs hasten recovery after colorectal resections”. World Journal of Gastrointestinal Surgery1 (2011): 1.
  35. Stowers MD., et al. “Health economics in enhanced recovery after surgery programs”. Canadian Journal of Anesthesia2 (2015): 219-230.
  36. Lee L., et al. “Cost-effectiveness of enhanced recovery versus conventional perioperative management for colorectal surgery”. Annals of Surgery6 (2015): 1026-1033.
  37. Delaney CP., et al. “Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery”. Annals of Surgery1 (2003): 67.
  38. Roulin D., et al. “Cost‐effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery”. British Journal of Surgery8 (2013): 1108-1114.
  39. Slim K., et al. “Half of the current practice of gastrointestinal surgery is against the evidence: a survey of the French Society of Digestive Surgery”. Journal of Gastrointestinal Surgery8 (2004): 1079-1082.
  40. Lassen K., et al. “Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries”. Bmj7505 (2005): 1420-1421.
  41. Kehlet H., et al. “Care after colonic operation—is it evidence-based? Results from a multinational survey in Europe and the United States”. Journal of the American College of Surgeons1 (2006): 45-54.

Citation

Citation: Salah Nashi AlOtaibi. “Is Enhanced Recovery After Surgery Pathway (ERAS) Influential in Reducing Length of Patients Stay in Colorectal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials”.Acta Scientific Medical Sciences 5.6 (2021): 149-157.

Copyright

Copyright: © 2021 Salah Nashi AlOtaibi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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Impact Factor0.851

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